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Downloaded 09/26/21 04:47 PM UTC Ona What, If Any, Extra-Pharmacological Factors Are Commonly SECTION 1 Related to the Adverse Reaction Known As a Bad Trip ORIGINAL ARTICLE Journal of Psychedelic Studies 2(1), pp. 53–60 (2018) DOI: 10.1556/2054.2018.001 First published online March 20, 2018 Inside bad trips: Exploring extra-pharmacological factors GENÍS ONA* Department of Anthropology, Rovira i Virgili University, Tarragona, Spain (Received: June 18, 2017; revised manuscript received: January 16, 2018; accepted: January 17, 2018) Objective: This study aimed to clarify the influence of extra-pharmacological factors in the etiology of bad trips,a common adverse reaction related to the consumption of psychedelic drugs. Methods: A descriptive approach was adopted. The information was collected using a web-based survey. The survey respondents volunteered to participate based on the condition that they had suffered a bad trip in the past. Results: This report reveals some variables that are commonly related to this adverse reaction (i.e., the recreational consumption of drugs, the consumption of drugs in large, open outdoor spaces, or being inexperienced with the drug). In addition, we note that some problems, which may be related to bad trips (i.e., mixing drugs, ignorance about the purity, or the dosage), can be solved through harm- reduction strategies. Conclusions: We found certain aspects that could be related to the appearance of a bad trip, but it is not possible to establish a causal connection. We recommend conducting prospective studies with larger samples to collect more information about the role of extra-pharmacological factors. Keywords: psychedelic, bad trip, drug, adverse reaction INTRODUCTION Carbonaro et al., 2016; Cohen & Ditman, 1963; Fink, Simeon, Haque, & Itil, 1966; Frosch, Robbins, & Stern, 1965; Glickman Psychedelic drugs like lysergic acid diethylamide (LSD-25), &Blumenfield, 1967; Heaton, 1975; Kleber, 1967; Malleson, 3,4-methylenedioxymethamphetamine (MDMA), and psilo- 1971; Smart & Bateman, 1967; Strassman, 1984), few studies cybin are being investigated again, showing therapeutic poten- specifically focus on bad trips (Barrett, Bradstreet, Leoutsakos, tial for certain psychological disorders, such as post-traumatic Johnson, & Griffiths, 2016; Carbonaro et al., 2016; Cohen, stress disorder (Amoroso & Workman, 2016; Mithoefer et al., 1960; Ungerleider, Fisher, Fuller, & Caldwell, 1968). 2013; Oehen, Traver, Widmer, & Schnyder, 2013) and de- Literature on psychedelic-induced states of consciousness pression and anxiety associated with life-threatening illnesses suggests that the extra-pharmacological factors are determi- (Grob et al., 2011; McCorvy, Olsen, & Roth, 2016). There are nant (Grof, 2005; Masters & Houston, 1974; Prepeliczay, dozens of references on this issue, so we suggest reading the 2002; Sumnall, Cole, & Jerome, 2006), because states of following recent reviews: Garcia-Romeu, Kersgaard, and consciousness induced by psychedelics potentiate perception Addy (2016) and Nichols, Johnson, and Nichols (2017). and experience of external stimuli (Grof, 2005). Alongside this therapeutic trend, recent studies have The delineation of these extra-pharmacological factors is begun to challenge the notion that the psychedelics are conceptualized in the notion of “set and setting,” that is to say, harmful to mental health (Krebs & Johansen, 2013). On the way the experience is influenced by the individual’s mind- the contrary, we may consider the possibility that the set (set) as well as the surroundings and atmosphere (setting). consumption of these drugs by healthy people in naturalistic In this study, the relationship between bad trips and a contexts could have benefits to mental health (Johansen & delimited list of extra-pharmacological factors will be explored. Krebs, 2015; Ona & Spuch, 2017). We note that all drug users are exposed to some adverse reactions (Grof, 2005; Strassman, 1984). These substances can METHODS exacerbate the psychopathological traits that could cause per- sisting adverse reactions (Cohen, 1960; Johnson, Richards, & Overview Griffiths, 2008; Strassman, 1984). When drug users do not have previous psychopathological traits, they may experience acute An online survey was developed to collect information about adverse reactions like fear, panic, overwhelming anxiety, or bad trips. This was designed with the intention of discovering confusion, which together constitutes what is commonly known as a bad trip. This phenomenon has not been studied * Corresponding address: Genís Ona; Interdisciplinary Psychedelic in depth. While there are important number of studies, which Studies, Medical Anthropology Research Center, Rovira i Virgili address the adverse reactions related to the consumption of University, Avda. Catalunya, 35, Tarragona 43002, Spain; Phone: psychedelics (Abraham & Aldridge, 1993; Bewley, 1967; +34 675 553344; E-mail: genis.ona@e‑campus.uab.cat This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium for non-commercial purposes, provided the original author and source are credited, a link to the CC License is provided, and changes – if any – are indicated. © 2018 The Author(s) Unauthenticated | Downloaded 09/26/21 04:47 PM UTC Ona what, if any, extra-pharmacological factors are commonly SECTION 1 related to the adverse reaction known as a bad trip. Introduction Basic information about the bad trip. Expected time for completion. Materials Basic instructions. Main investigator contact details. The survey was designed with closed-ended questions with defined response categories. At the conclusion of the survey, participants were also given the opportunity to provide any other comments they wished to on the section topic. The first section of the survey was used to determine SECTION 2 ’ Antecedents participants eligibility. Participants were provided with in- Organic or psychological diseases, if formation about the survey, including the purpose and assur- any. ance of anonymity. Respondents were asked to recall their Prescribed medications, if any. bad trip and answer the questions about that experience. If they had experienced more than one bad trip,theywereasked to choose the one they considered to be the most significant. The demographic section of the survey asked participants SECTION 3 for information including age, education, occupation, and Context country of residence. Type of context. fi Open outdoor / indoor space. Themainbodyofthesurveyhad ve sections concerning Size of the space. respondents’ medical history, the context of the experience, Number of people in the space. the drug used, the experience, and the after-effects. A sche- Music style, if any. Music volume, if any. matic diagram of the survey instrument is provided in Figure 1. Illumination of the space. The full survey is available from the authors upon request. Procedure The survey was hosted online using the Google Forms SECTION 4 Drug platform (docs.google.com/forms) and shared on social Which psychedelic. media with the collaboration of various organizations from Dose. Purity of the drug. Spain and other Latin American countries (e.g., Energy Poly-drug use Control, Caapi, Échele Cabeza cuando se dé en la Cabeza, Previous experience among others). Only drug users who had suffered a bad trip were requested to complete the survey. Sample SECTION 5 Bad trip A total of 233 volunteers aged between 18 and 54 years Valuation of the experience. (X = 23.6) completed the survey. Two subjects were ex- Positive or negative ending. Medication used, if any. cluded from the study, because the supposed bad trip they Learnings gained, if any. suffered did not emerge in response to the consumption of a psychedelic substance. Data analysis SECTION 6 Post-effects IBM SPSS Statistics v.21 was used to analyze the survey Long-term adverse reactions, if any. data. The results are reported in percentages. Flashbacks occurrence, if any. Changes in interaction with others. Consumption of the same psychedelic. Ethics Consumption of other psychedelics. Medication used during the days or weeks after the bad trip, if any. This study has been conducted in accordance with the ethical principles set out in the declaration of Helsinki. RESULTS SECTION 7 Sociodemographic information Sociodemographic information The majority of the sample reported had completed univer- Figure 1. Schematic diagram of the survey sity studies (64.5%), whereas 14.7% had completed high- school studies and 10.8% had master’s or doctorate degrees. 54 | Journal of Psychedelic Studies 2(1), pp. 53–60 (2018) Unauthenticated | Downloaded 09/26/21 04:47 PM UTC Inside bad trips About 48.7% of participants were students, whereas The majority of the sample (57.1%) took the drug in open 46.1% were professionals and 5.2% were unemployed. outdoor spaces, whereas 42.4% took in indoor spaces. A majority of respondents reside in Colombia (40.7%), Regarding the size of the space where the bad trip took whereas 11 other nationalities are represented in the place, 63.2% of the sample classified the space as large results [Spain (28.5%), Mexico (11.2%), Argentina with 36.6% of them reporting that the size was “over- (9.1%), Chile (3.4%), Ecuador (1.3%), Portugal (1.3%), whelming.” About 36.8% of the sample classified the space United States (0.9%), France (0.9%), Germany (0.9%), as small with 12.9% of them reporting that this size was Peru (0.4%), and Panama (0.4%); see this information “overwhelming.” in Table 1]. There were less than 10 people in the same space in 44.1% of the cases; more than 10 in 27.7% of the cases; and more Medical history of the sample than 50 people in 13.4% of cases. About 14.7% of the sample reported having being alone during the time of the bad trip. About 78.3% of the sample did not report any physical There was music playing in 78.4% of the cases. About condition before the bad trip. The rest of the sample 26.3% of respondents reported that they liked the music reported asthma (7.3%), hypoglycemia (1.7%), gastritis style, whereas 7.8% did not like it. We do not have (1.3%), arrhythmia (0.9%), atopic dermatitis (0.9%), or information about the remaining 44.3%. In this “music hypothyroidism (0.9%), among others.
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